The health of the individual recapitulates the health of the community

Sunday, September 9, 2007

ABCs

Guess I should have brought this up earlier.

The first condition an ER nurse assesses of EVERY patient, whether presenting through triage or via EMS (Emergency Medical Service) is A for airway. Specifically, is the patient's airway patent or obstructed? Nothing else an ER nurse can do makes much sense if this fact is not established and, if necessary, corrected.

If obstructed, the ER nurse must take action to open the airway, either by repositioning the head and neck or by extracting any obstructing foreign body from the throat. If the airway is patent, does the patient require assistance in maintaining his/her patent airway?

Once this fact has been established, the ER nurse can move on to the next essential assessment: B for breathing. The nurse must assess the respiratory effort (if any) of the patient. At this point, nothing else an ER nurse can do makes much sense if this fact is not established and, if necessary, corrected.

Is the patient breathing on his/her own? At what rate? How effectively? Does the patient need assistance to breath? Does the patient require supplemental oxygen?

Once the patient is effectively breathing, either own his/her own or with assistance, the nurse can move on to the next essential assessment: C for circulation. The nurse must assess whether or not the patient has a pulse. At this point, nothing else an ER nurse can do makes much sense if this fact is not established and, if necessary, corrected.

Does the patient have a pulse? What is the heart rate? What is the quality of the pulse (i.e., regular, strong)? Do conditions exist that might compromise blood circulation (e.g., bleeding, blood clots, crushing injuries to vessels)? What is the patient's blood pressure?

Although it is easy to understand why this algorithm of assessment is important in the case of chest pain or gun shot wound patients, it is less understandable in treating patients for back pain or sore throats.

In fact, the assessment algorithm is always implicitly performed, but often quickly and, perhaps, unconsciously by the ER nurse through observation. Patients who present talking (1) have a patent airway, or else they would not be able to vocalize; (2) are breathing, or else ibid; and (3) have a pulse, or else ibid.

Do not think that just because a nurse does not explicitly assess your airway or breathing or pulse when you present for a finger laceration, that the nurse has not done so.